Pediatric Clerkship Objectives

1. Clinical Skills
   1. Data Gathering (Make sure you are observed and receive feedback)
      1. History
         1. Obtain a focused history (outpatient)
            1. Identify the chief complaint
            2. Identify any hidden agendas (chief concern)
               1. Patient
               2. Parents
            3. Identify pertinent positives
            4. Identify pertinent negatives
            5. Determine level of illness (dangerously ill vs. sick but stable)
         2. Obtain a complete history (inpatient)
            1. Make patient comfortable
            2. Good flow and order
            3. Approach patient in a developmentally appropriate manner (e.g. Adolescents - interview alone/HEADSS history)
      2. Physical Exam (Make sure you are observed and receive feedback)
         1. Perform a complete physical (inpatient)
            1. Maintain Privacy(use sheets/drapes)
            2. Make patient comfortable
            3. Efficient Order
            4. Developmentally appropriate approach
         2. Perform a focused physical (outpatient)
         3. Identify pertinent positives
         4. Identify pertinent negatives
         5. Determine level of illness (dangerously ill vs. sick but stable)
         6. Develop specific pediatric physical exam skills
            1. Newborn exam
            2. Hip exam
            3. Genitalia (normal / abnormal)
            4. Ears
            5. Throat
            6. Murmurs (Benign Systolic Vs. VSD/PPS/MR/AS)
            7. Lung sounds
            8. Abdominal exam
            9. Assess hydration status
   2. Data Synthesis
      1. Problem List
         1. Group patient issues systematically and by importance
      2. Determine Level of Illness/ Report it in a prioritized manner
      3. Differential Diagnosis
         1. Develop appropriate working diagnosis for each patient (core knowledge)
         2. Develop a differential diagnosis of at least 3 for common complaints with rationale
      4. Treatment Plan
         1. Formulate plans for each problem
         2. Consider cost and invasiveness in approach
         3. Identify criteria for calling consults
         4. Call consults with specific questions
         5. Use consult information effectively
         6. Identify criteria for and benefits of inpatient and outpatient treatment
      5. Problem Anticipation (included in each problem on the list)
      6. Patient Summary ("bullet")
         1. Synthesize key H&P findings, labs/studies and treatment plan / progress in 4 - 5 sentences
      7. Communicate effectively with colleagues by:
         1. Writing clear, complete progress notes that identify and prioritize the patient's problems
         2. Writing admission notes that fully describe your thought process
         3. Presenting concisely and effectively on work rounds
         4. Presenting concisely and effectively to attendings
      8. Complete two inpatient write-ups
      9. Present Patients in either one of 3 formats:
         1. Bullet
         2. SOAP
         3. Formal - You must be able to move from one to the other as requested and clarify which one is called for in various contexts
             
2. Knowledge
   1. Core
      1. Mechanisms
      2. Disease
      3. Diagnostic
      4. Treatment
      5. Development
      6. Core Cases
      7. Board Questions - 10 per week
   2. Depth — Critical Assessment of Current Literature
      1. Evaluate findings from variety of articles
      2. Evaluate quality of studies for each article
      3. EBM Project - use EBEM.org website and other sites for reference
          
3. Professional Development /Management Skills
   1. Approach
   2. Understand multiple perspectives (development, gender, race, culture)
      1. Physician
      2. Patient
      3. Family
      4. Significant others
   3. Choose patient's perspective over your own (altruism)
   4. Demonstrate initiative and eagerness to learn
   5. Patient Management Skills — Steadily advance through levels of clinical care
      1. Observer -- watch what happens
      2. Reporter -- describe what happens
      3. "Editorial writer" -- offer some opinions as to what happens
      4. Independent worker -- perform most tasks autonomously
          
4. Interpersonal Skills
   1. Follow template of Effective Communication and Patient Education
      1. Set comfortable environment
      2. Open ended first minute
      3. Clarify Concerns
      4. Elicict Patient's Underlying Worries
      5. Summarize your own understanding
      6. Share Information
      7. Make joint Decision
      8. Clarify Patient's understanding
      9. Always tell patient what to expect after you leave
   2. Communicate effectively and honestly with patients and families regarding:
      1. Differential diagnosis
      2. The working diagnosis and prognosis
      3. Effects of hospitalization on children and family
      4. Preparation for potentially frightening and painful procedures
      5. Treatment instructions and anticipatory guidance
   3. Share knowledge effectively with peers
      1. Actively teach and learn from other students
      2. Facilitate collegial interaction by sharing credit
   4. Work effectively with other healthcare professionals
      1. Attendings
      2. House staff
         1. Always check in with people you are working with
         2. Provide them with a written weekly schedule of your whereabouts and call schedule
         3. Frequently inform them of your progress in performing your tasks
         4. Always inform them of changes before the case, not after the fact
      3. Nurses
      4. Other hospital staff
      5. Other students
   5. Develop effective therapeutic relationships with patients
   6. Choose to place patient needs above your own

Neonatology Objectives

1. Physical examination of newborns, including screening for congenital abnormalities (cardiac, abdomenal, genital, hip and HEENT).
2. These sessions also provide opportunities for you to counsel new parents about the anxiety of parenthood and educate new mothers about proper breast feeding technique.
3. Other specific subject matter to cover includes: the jaundiced infant, prematurity / RDS, meconium aspiration, gestational age assessment, and Apgar scoring.